Probably the most important characteristic of humans is the capacity to form relationships. These relationships are so necessary for us to survive, work, learn, love and pro-create.
Each person’s ability to form relationships differ – some seem naturally capable of loving, others feel no “pull” to form intimate relationships and find little pleasure from being with others. In some cases an individual may have no intact emotional bond and can be self absorbed, aloof and may even present with classic neuropsychiatric signs of being schizoid or autistic.
We all at some time prefer to pick up the remote or i-phone, or connect to the Internet – rather than have a conversation with our spouse, children or co-workers. Sometimes connecting to the virtual world is just simpler than connecting with humans. What is unique about relationships in the 21st century is that the performance bar has been set even higher. To get a little bit of love and human connection, parents, children and colleagues are now required to compete with the seductive lure of technology, which is threatening the very fabric of life as we used to know it. Family, school and workplaces are on the verge of disconnection from self, others and nature. Identity and attachment formation can only happen in relationship to others, and is best facilitated in nature based environments. Connection to technology is causing a disconnection from what we used to hold dear!
Human attachment is a biological need, without which, we would actually die. For hundreds of years humans have been ‘pack’ animals. While technology was designed for human efficiency; it has also had the effect of diminishing the need for the ‘pack’. Can humans adapt to this growing sense of isolation from each other and what will be the impact be on infants and children who have little or no human contact with their parents?
The capacity and desire to form relationships is related to the organization and functioning of specific parts of the brain. The system in the brain that allows us to form emotional relationships develops during infancy in the first years of life. Experiences during this critical period shape the capacity to form healthy relationships. Empathy, caring, sharing, inhibition of aggression, capacity to love, and a host of other characteristics of a healthy, happy and productive person are related to the core attachment capabilities formed in the early years of life.
The word “attachment” is used frequently but tends to have different meanings in different contexts. As human beings we create so many different kinds of ‘bonds’, simply seen as a connection between one human and another. During an infants development the word attachment refers to a very special bond characterized by the unique qualities in a primary caregiver – infant relationship.
An attachment bond is an enduring emotional relationship with one person in which the relationship brings safety, comfort and pleasure and a threat of loss of that person brings on extreme anxiety and distress.
Bonding is seen to be the process of forming an attachment and therefore involves a set of behaviours that help lead to an attachment. Can we then assume that bonding is genetically determined? The answer is most certainly yes! In the infants basic drive to survive it knows that its dependence on a caregiving adult is crucial for it’s survival. The maternal response to this dependence gives way to a relationship and an attachment is formed.
However, despite the genetic potential for bonding and attachment it is the nature, pattern and intensity of early life experiences that express that genetic potential. It goes without saying that without that much needed predictability, responsive and nurturing care giving the infant’s potential for bonding and attachments will be unrealized. The brain systems responsible for healthy emotional relationships will not develop in the best way without the right kinds of experiences at the right times in life.
For some care-givers the “right kinds of experiences” are created naturally, however for those that struggle with the acts of holding, rocking, singing, feeding, kissing and other nurturing behaviours need to know that creating such experiences are crucial to the bonding experience. Spending quality (and actually quantity) time together with face-to-face interactions, eye contact and physical touch alongside primary sensory experiences encourages bonding. Such activities also cause specific neurochemical activities in the brain. These chemical processes lead to normal organization of brain systems that are responsible for attachment.
The child’s most important relationship in their life is the attachment to his or her primary caregiver — their very first relationship! This first relationship determines a biological and emotional ‘template’ for all future relationships.
Healthy attachment provides the solid foundation for future healthy relationships, in contrast, problems with bonding and attachment can lead to a fragile biological and emotional foundation for future relationships.
It needs to be said that healthy practices that encourage bonding need to be implemented from pregnancy but the focus should primarily be on the first three years of life when the brain is most malleable where the foundations for life are forged. During this time period the brain puts in place the majority of systems and structures that will be responsible for all future emotional, behavioural, social, and physiological functioning during the rest of life. These are critical periods during which bonding experiences must be present for the brain systems responsible for attachment to develop normally.
The majority of us won’t experience such a severe neglect of these experiences however many millions of children have experienced some degree of impaired bonding and attachment during early childhood. The problems that result from this can range from mild social discomfort to profound social and emotional problems. In general, the severity of problems is related to how early in life, how prolonged, and how severe the emotional neglect has been. It often takes a lot of hard work to attempt to repair such damaged relationships and can become very frustrating for families involved.
|To classify attachments studies have identified four categories of attachment:
Securely attached children feel a consistent, responsive, and supportive relation to their mothers even during times of significant stress. Insecurely attached children feel inconsistent, punishing, unresponsive emotions from their caregivers, and feel threatened during times of stress.
Many factors can influence bonding and attachment. When the interactive, reciprocal relationship between the caregiver and infant is disrupted or difficult, bonding experiences are difficult to maintain. Disruptions can occur because of primary problems with the infant, the caregiver, the environment, or the “fit” between the infant and caregiver.
1. The child’s basic nature influences bonding. If they are difficult to comfort and irritable he or she will have more difficulty developing a secure attachment. The infant’s ability to participate may be compromised due to a medical condition, such as prematurity, birth defect, or illness – factors beyond the caregiver’s control. At this early stage in life, intervention is based on environmental modifications, developmentally supportive positioning and mother child interactions rather than physical handling of the baby.
As the sensory environment of the neonatal intensive care unit (NICU) is vastly different from that of the womb this environment can be highly stressful to the high-risk infant’s already disorganized and vulnerable central nervous system. As a result of the infants immature neurological functions as well as their difficulty maintaining physiological stability their response to this stressful situation is influenced and they are then at risk for developmental delay, neuromuscular and behavioural problems. It is important to try to reduce the environmental stimulation as far as possible to reduce the stress to the infant and promote infant development. Reduce lighting in wards/bedrooms – the darker the environment the better for the preterm infant and avoid direct sunlight – curtains should be drawn.
Typical noise in an NICU can be equivalent to or louder than heavy traffic to the neonate. Sound in the NICU should not exceed 40 decibels, the hearing threshold in the infant of 28-34 weeks gestation, as louder noises are potentially harmful to the infant’s auditory system. Increased noise level also result in behavioural and physiological changes that can lead to developmental challenges. As noise is highly stressful to the high-risk infant, agitation and crying can result which leads to decreased oxygenation but increased respiration and heart rate as well as increased intracranial pressure. Keep noise to a minimum and establish a quiet period where there is no noise/disturbances to allow adequate sleep (2-3 hours of continuous sleep), this includes ward rounds and medical procedures as far as possible.
Frequent handling of the preterm or high-risk infant results in disturbed sleep. Lack of sleep leads to decreased weight gain, decreased self-regulation as well as neurobehavioral disorganization. Routine procedures in the NICU that require handling of the infant often result in significant and prolonged decreases in oxygenation. Limit physical handling of the infant as far as possible, when handling cannot be avoided slow gentle movements should be used. Talk to the infant as you approach and touch the child before lifting or removing blankets. When holding or handing over the infant make use of an upright foetal position.
A preterm infant’s movement are wide, away from the body, disorganized and unmodulated. In addition due to their poor self-regulation abilities and disorganized motor skills the infant is unable to bring his/her hand to their face to calm and self soothe. Without assistance through therapeutic positioning the infant’s excessive and uncontrolled movements may further impact on physiological instability. Further a preterm infant is at risk of positional deformities as a result of their low muscle tone, immature motor control, primitive reflexes and the effect of gravity when in inappropriate positions.
The purpose of therapeutic positioning in the NICU is to provide the high-risk infant with containment of the extremities through promoting flexion of the trunk and limbs towards the midline. Hands to the midline, near the face, promotes the development of hand to mouth activity, symmetry and self soothing and organizing behaviours. Decreasing the infant’s level of physical activity reduces stress which results in improved developmental outcomes. Cover with a light blanket at all times. Swaddle to encourage flexion and hands to midline (imitate the intrauterine experience) – swaddling provides neutral warmth and containment of excessive movements that promotes self regulation of stress states as well as temperature and tactile input.
It is important to encourage parental involvement with the high risk infant as this facilitates the emotional bond between the mother and child which is important for healthy attachment. Skin to skin holding (Kangaroo Care) – hold the infant close to chest wearing just a nappy to encourage bonding. This also allows the infant to hear the mother’s heart beat and breathing and give easy access to feeding as well as facilitating thermoregulation. Place one finger in child’s hand while holding the infant encourages a palmar reflex which increases the infant’s organizationand mothers should speak to their child in a soft voice.
Preterm and high-risk infants display various signals that show either organization or disorganization and stress. It is important to observe the infant and provide them with the necessary facilitation to maintain a calm and organized arousal state as this allows for optimal development.
Approach Behaviour 1,4
Preterm infants that display approach behaviours show that they are able to tolerate stimulation and are ready for interaction.
1- Smiling or mouthing
2- ‘ooh’ face & cooing sounds
3- Relaxed limbs with movements that are smooth and not excessive
4- Alertness with soft, relaxed facial expressions
5- Holding parent or care givers finger
6- Leg or foot brace against swaddling or nesting
7- Tongue extension
Coping behaviours are an early warning that the infant is becoming stressed and requires a time out to allow them to draw on their own self regulatory mechanisms to maintain a calm alert state.
1- Leg bracing
2- Hand on face
Self regulatory behaviours4
These behaviours are show a clam alert and organised awake state. They allow the infant to protect themselves against stressful input through avoiding interaction without assistance.
2- Hand or foot clasp
3- Grasping or fisting
4- Assuming a flexed position
5- Bracing body against swaddling or crib boundaries
6- Shifting to lower level of arousal such as drowsy or light sleep states
Avoidance behaviour 4
These behaviours show overstimulation, increased stress levels and decreased self regulation. As a result the infant is disorganised and requires assistance to regain a state of homeostasis.
1- Stressed or hyperextended when moving from prone to supine
2- Alertness while awake:
3- Unused leg bracing, tight fisting, hands on face in protective mechanism
4- Diffuse sleep/awake states, strained fussing or crying, eye floating/aversion
Changes that help calm the disorganised infant
1- Swaddle the infant to provide limb containment and a bracing surface to assist self regulation
2- Change level of stimulation in the environment such as lighting and noise.
3- Provide the infant with a quiet time while holding him firmly to give him a sense of security
4- Allow the infant to hold onto your finger until calm
5- Talk softly to the infant and talk to him before touching or moving him as this may startle him causing additional stress
6- When he is calmed and ready to interact begin slowly and a calm face, soft voice and gentle touch.
2. The caregiver’s behaviors can also impair bonding. Critical, rejecting, and interfering parents tend to have children that avoid emotional intimacy. Abusive parents tend to have children who become uncomfortable with intimacy, and withdraw. The child’s mother may be unresponsive to the child due to maternal depression, substance abuse, overwhelming personal problems, or other factors that interfere with her ability to be consistent and nurturing for the child.
Being a parent and forming a relationship with one’s baby is a complex process and involves being different factors. It is a process and there is no such thing as a perfect parent. Rather it is important that parents/care-givers are good enough. ‘Good enough’ parents protect and comfort their babies, play with, praise and enjoy them. They also sometimes get it wrong! However try to repair it or correct the mistake. In response the babies will interact, explore the world and show happiness/pleasure. What is therefore important is the ability to repair and try again.
Remember to take time out and relax – there are other parts to your life. Sleep! A lack thereof can negatively impact on your ability to cope. Spend time with your baby and be self aware and talk to someone you trust if you feel that battling to bond with your child.
3. The environment can impair bonding. A major impediment to healthy attachment is fear. If an infant is distressed due to pain, pervasive threat, or a chaotic environment, they will have a difficult time participating in even a supportive caregiving relationship. Infants or children in domestic violence, refugee situations, community violence, or war zone environments are vulnerable to developing attachment problems. The ‘environment’ can extend as far as the womb where parents have already decided to give the child up for adoption and already emotionally ‘cut’ the child off as well as children who were created as a result of a rape. Growing up with a step parent or grandparents are also possible barriers to bonding as well as the mom who suffers from post natal depression and is emotionally unavailable for her child.
These environmental barriers to bonding need to be acknowledged and measures put in place to encourage a repair of the broken bond and the strengthening of new, healthier ones. Getting support through enrolling your child at a high quality crèche close to your place of work increases the amount of emotionally available care-givers to your child. Most people spend huge amounts on education from 5yrs upwards without realizing the need or importance of ‘education’ in the first three years.
Including your infant/toddler in everyday experiences: cooking, cleaning, bathing, reading stories and ‘rough play’ with lots of physical touch and verbal affirmations with eye contact, gentle voice and positive facial expressions all encourage the bonding experience. Creating a structure (singing a song to each other or massaging aromatic oils on your baby) for bonding to take place leaves little room for fear and empowers both the care-giver and child to move emotionally closer to each other.
4. The “fit” between the temperament of the infant and those of the mother is crucial. Some caregivers can be just fine with a calm infant, but are overwhelmed by an irritable infant. The process of reading each other’s non-verbal cues and responding appropriately is essential to maintain the bonding experiences that build in healthy attachments. Sometimes a style of communication and response familiar to a mother from one of her other children may not fit her new infant. The mutual frustration of being “out of sync” can impair bonding.
The problems of children with attachment issues will vary depending upon the nature, intensity, duration, and timing of poor bonding. Some children will have profound and obvious problems, while some will have very subtle problems that you may not realize are related to early life neglect. Sometimes these children do not appear to have been affected by their experiences. Here are some cues to children with attachment problems:
Responsive adults, such as parents, teachers, and other caregivers make all the difference in the lives of poorly bonded children and can assist in early interventions that can short circuit adult mental illness as a result of poor childhood binding and attachment experiences.
The impact of technology on attachment formation has not received nearly enough attention. Research des indicate that fear of intimacy is an underlying factor for addictive and self-harming behaviours in adults, and this fear has it’s origin in failed primary attachment. We also know that attachment to technology is resulting ‘detachment’ from all that is fundamentally human. One only has to reflect briefly on the following statistics to know that something is seriously wrong with how we are raising and educating our children – 15% of children are obese, 15% are developmentally delayed, 14.3% diagnosed with mental health disorders and 20-30% experience learning difficulties (USA stats). The American Journal of Psychiatry reports that internet addiction in now the fastest rising mental illness in adults.
With all this connection to technology, primary relationships are disconnecting or worse not even forming at all. Attachment profoundly affects all aspects of human development: mind, body, emotions, social ability, values and productivity. We know that securely attached infants, toddlers and children have better self esteem, independence, autonomy, enduring friendships, trust, intimacy, impulse control, empathy, compassion and resilience. What will happen when people with insecure attachment styles dominate society? Relatedness will truly be a characteristic of the past as humans grow ever more isolated, yet at the same time, ever more needy.
Nicole Love – Educator
Kerry Weir-Smith – OT
Cheryl Bennie – OT
Robyn-Leigh Smith – Psychologist